As online learning increases and classroom use of print textbooks are gradually replaced by web-based instruction, what features of online instruction prove beneficial to student learning? The present study has three purposes; (1) To examine the effects of conversion of textbook content to web-based instruction for an extant Internet search course. The researcher examined performance differences of an online textbook to web tutorial compared to a second version that included interactive features found in classroom instruction. (2) To investigate students perceptions of material that afforded high levels of learner control and compared responses to a more structured instructional module. (3) To document the design process used to convert textbook material to web-based instruction. GagnsÌ? Events of Instruction (1985) differentiated features for comparison and treatment online modules; one featured content-centered, the other learner-centered instructional strategies.

This study documents an experience in which a small group of cognitively and developmentally disabled adults expressed their personal goals and views related to art museum visits. A review of literature related to disability studies, museum access and inclusive programs, art therapy, and person-centered thinking provide background and context. Case study and qualitative interviews are used as methodologies to support an investigation of the use of person-centered thinking in the implementation of art museum programming for the study participants. Person-centered thinking is considered and assessed as an approach to structuring meaningful collaborations between visitors with disabilities and art museums. Data collected in the forms of visual and written response, observation, and documentation of interviews inform the findings, discussion, and analysis of the study's research goals. The resulting case study may be used by museums to structure visits with similar groups. This study contributes to a growing body of knowledge pertaining to how museums can best collaborate with disabled populations to create inclusive programs.

Wind power, as a source of renewable energy, is growing very fast. Especially so, is consideration given to offshore wind farms where expansion is due in part to limited social and visual impact, reduced noise effect of turbines, and at the same time higher production of offshore wind turbines. Maintenance is always a considerable and costly part of the wind power investment, especially for offshore projects, but it could not improve as fast as the increasing wind industry in the world. The operation and maintenance management of wind farms should have always a reliable and structured planning to have an economical investment. At the beginning of the growth of wind industry, companies tried to transfer responsibilities of the failure and loss of production to the insurance companies, but it cannot be continued any more. These days even the insurance companies ask about regular inspection or condition monitoring. In other words, they ask for a reliable strategy for operation and maintenance. Both preventative and corrective maintenance are used in offshore wind farms. Preventive maintenance is usually performed at the first sign of failure, and in so doing it helps reduce costs associated from lost production. Having a perfect preventive maintenance program is not easy and it usually needs more inspection and online monitoring. To select a suitable strategy, data should be gathered from different stakeholders who are involved in the project. The stakeholders could be turbine designers, construction companies, transportation companies, operation staff, etc. The reason is that each group has the data which could help to define a reliable strategy of maintenance. Reliability includes measurements, e.g., failure rate, repair time, and availability. Reliability is the ability of components or system to perform their function under given operational condition and for a predicted period of time. However always preventive maintenance especially for offshore wind farm is faced with uncertainty due to bad weather, access difficulty, and logistic limitation. Reliability Centered Maintenance (RCM) is a systematic qualitative technique that balances preventive and corrective maintenance. It chooses the right preventive maintenance activities for the right component at the right time to reach the most cost efficient solution. This research points out that RCM, as an experienced methodology in other industries, could be a good method for scheduled preventive maintenance in offshore wind power for purposes of lowering cost while improving reliability and safety. RCM implementation is always facing with uncertainty. Engaged uncertainty to RCM is known as Reliability and Risk Centered Maintenance RRCM and it could lead maintenance process to an optimal preventive schedule with minimum uncertainty.

Bakgrund: Ronden är en central punkt gällande planering och utvärdering av patientens vård. Sjukvårdspersonalen ansvarar för att personcentrera omvårdnaden där patienten sätts i fokus, och där vården byggs på respekt för patientens självbestämmande och integritet. Den traditionella ronden utförs i större del utan patientens närvaro. Bedside-rond (BR) syftar till att alla inblandade professioner rondar tillsammans med patienten vid patientens sängkant eller i ett avskilt rum för att göra patienten delaktig i sin egen vård.   Syfte: Litteraturstudiens syfte var att beskriva om BR bidrar till personcentrerad vård, delaktighet och förbättrat teamarbete, ur patienten och sjukvårdspersonalens perspektiv.   Metod: En litteraturstudie baserad på tio vetenskapliga originalartiklar. Databaser som användes i studien var PubMed, CINAHL och SveMed+. Resultatanalysen gjordes utifrån Graneheim och Lundmans (2004) kvalitativa innehållsanalys.   Resultat: Resultatet av denna studie indikerar på att patienten och sjukvårdspersonalen upplever en ökad delaktighet genom BR. Sjukvårdspersonal upplever förbättring i utfallet av vården eftersom hela sjukvårdsteamet får en helhetsbild av patienten. Flera studier styrker att samarbetet i teamet förbättrades, och att BR bidrog till en ökad förståelse för varandras yrkesroller. Oenigheter rörande rondens mål framkom, men även avsaknad av en tydlig struktur försvårade genomförandet. Kommunikationen förbättrades enligt flertal studier, vilket framförallt berodde på den direkta kommunikationen mellan berörda teamdeltagare.   Slutsats: BR skulle kunna införas som arbetsmodell istället för den traditionella ronden. Patienten blir mer delaktig i sin vård och samarbetet förbättras genom en effektivare kommunikation. Resultatet visar att patientens delaktighet ökar men för att kunna säkerhetsställa evidensen att patienten upplever att BR bidrar till en personcentrerad vård, behövs ännu mer forskning ur ett patientperspektiv. / Background: The round is a central part regarding planning and evaluating the patients’ health. Healthcare professional are responsible for the person-centered healthcare where the patient is the center of attention, and where the healthcare is based on the patient’s integrity and autonomy. The traditional round is carried out mainly without the patient’s presence. Bedside-round (BR) aims at all professions involved with the patient at the patient’s bedside or in a separate room to make the patient involved in his or her own care.   Aim: The purpose of the literature study was to describe whether BR contributes to person-centered care, participation and improved teamwork, from the patients’ and the healthcare professionals’ perspective.   Method: A literature study based on 10 scientific original articles. Databases used in the study were PubMed, CINAHL and SveMed +. The results analysis was based on Graneheim and Lundman's (2004) qualitative analysis method.   Results: The result of this study indicates that the patient and healthcare professionals experience increased participation through bedside-round. Healthcare professionals experience improvement in the outcome of care as the entire healthcare team gets an overall picture of the patient. Several studies confirm that team collaboration improved, and bedside-round contributed to an increased understanding of each other's professional roles. Disagreements concerning the goal of the round came true, but lack of a clear structure also complicated implementation. Communication improved according to several studies, mainly due to the direct communication between relevant team participants.   Conclusion: BR could be introduced as a working model instead of the traditional round. The patients becomes more involved in their care and the collaboration is improved through more effective communication. The result shows that the patient's participation increases but in order to ensure the evidence that the patient experiences that BR contributes to a person-centered care, even more research is needed from a patient perspective.

Background: The number of people suffering from myocardial infarction in Sweden is decreasing, despite this the prevalence is high. Being diagnosed with myocardial infarction results in medical interventions, lifestyle changes and eventual pharmacological treatment to prevent relapse. Aim: The aim of this study was to describe patients' experience of life after amyocardial infarction. Method: A literature-based study was used, based on ten qualitative articles. The articles were analyzed in a five step-model, which resulted in three main-themes and sixsub-themes. Results: The results present life after myocardial infarction as difficult to understandand manage. This could be related to their physical and mental changes, which resulted in fear and anxiety that affected their everyday lives through experienced limitations. Fatigue where also a contributing factor in the limitations of everyday life due to energyloss. This was hard to handle without support from both relatives and health care professionals. It was essential to be meet as a unique human and not reduced to a diagnosis. Life became more valuable through the survival and gave the individuals a second chance with different priorities. Some adjusted to the lifestyle changes, while others were reluctant. Returning to work where seen as an indicator for being healthy and a return to life as before. Conclusion: To establish well-being and security through nursing, a holistic approach that is the basis of person-centered care helps nurses to see the individual situation. / I Sverige minskar antalet personer som drabbas av hjärtinfarkt trots detta är förekomsten fortfarande hög och ca 5800 avlider varje år. Hjärtinfarkten medför både fysiska och psykiska förändringar hos den drabbade. Syftet med denna litteraturstudie är att belysa patienters upplevelse av livet efter en genomgången hjärtinfarkt. I studiens resultat framkom det att både män och kvinnor såg situationen och livet efter en hjärtinfarkt som svår att hantera, då både kroppen och hjärtat inte längre upplevdes pålitligt. Detta resulterade i rädsla och oro som begränsade det vardagliga livet. Personerna upplevde att det var svårt att tolka kroppsliga signaler, vilket gav en osäkerhet som resulterade i ångest och katastrof tankar om döden. Detta medförde även att de inte vågade anstränga sig fysiskt. Känslor som ilska, frustration och nedstämdhet upplevdes på grund av den mentala och fysiska utmattningen som var svår att förstå. Personerna kunde inte utföra vardagsaktiviteter i samma utsträckning som innan hjärtinfarkten, vilket resulterade i en känsla av passivitet. Det utrycktes även ett behovav stöd från anhöriga och vårdpersonal för att klara av sin situation och det vardagligalivet. Vårdpersonalens bemötande och agerande var avgörande för hur patienterna förstod informationen som gavs, deltog i rehabilitering och klarade att genomföra nödvändiga förändringar när det gäller ohälsosamma levnadsvanor. Vårdpersonalens förmåga att skapa en trygg atmosfär tillsammans med att se patienten som människa var viktigt för att uppnå välbefinnande. Anhöriga sågs som en resurs för personerna då de kunde avlasta vardagssysslorna samtidigt som de lyssnade, vilket gav trygghet och välbefinnande hemma. Patienter upplevde att familjen satt för höga krav och fick då stödet från vänner. Partnerrelationen kunde påverkas genom den minskade sexuella relationen som grundade sig i rädsla för de fysiska förändringarna och upplevdes svårt att prata om med partnern. Livet efter en hjärtinfarkt beskrevs som en ny chans till livet där nya värderingar uppstod. Personerna upplevde att arbetsgivarens attityd och förståelse för situationen var avgörande för fortsatt sjukskrivning. För att kunna möta patientens unika behov och skapa välbefinnande genom omvårdnad, är personcentrerat förhållningssätt lämpligt för att vidhålla en helhetssyn på patienten och inte bara det fysiologiska tillståndet.

Bakgrund: Idag finns cirka 150 000 individer i Sverige med demenssjukdom och gruppen växer i takt med att befolkningen blir äldre. Personcentrerad vård har sitt ursprung inom humanistisk psykologi och begreppet beskrevs redan på 1960-talet. Personcentrerad vård är en av sjuksköterskans sex kärnkompetenser och är en god grund för att tillgodose de varierande behov som finns hos den komplexa patientgruppen. Syfte: Syftet med litteraturstudien är att belysa vad sjuksköterskans erfarenheter är av att ge personcentrerad vård till patienter med demenssjukdom. Metod: En litteraturstudie vars resultat baseras på studier med kvalitativ ansats. Vid sökning användes databaserna; CINAHL, PsycINFO och PubMed. Resultatets femton artiklar analyserades enligt Forsberg och Wengströms (2016) femstegsmetod. Resultat: Resultatet presenterades med hjälp av fyra huvudteman; organisationen, patientrelationen, kommunikation, vårdmiljö samt sju underteman; stöd på arbetsplatsen, kompetensutveckling, tids- och personalbrist, livsberättelsen - patientens historia, personliga attribut, samverkan i team och dokumentationsrutiner. Konklusion: Hälso- och sjukvården är en komplex organisation och sjuksköterskan står inför många utmaningar. Otillräckligt stöd från både ledning och kollegor samt vårdmiljöns utformning var alla faktorer som påverkade sjuksköterskans möjlighet att tillgodose personcentrerad vård. Vidareutbildning i kommunikation och demenssjukdomar upplevde sjuksköterskorna gynnsamt för deras arbete. Även vikten av att ha en god relation till patienten och att lära sig deras livshistoria framhölls som viktiga komponenter i den personcentrerade vården. / Background: Today there is approximately 150 000 individuals with dementia in Sweden and the group is expanding at the same time the population is ageing. Person centred care has its roots in humanistic psychology and the concept was described already in the 1960’s. Person centred care is one of the nurses’ six core competencies and is a good foundation for the various needs amongst the complex patientgroup. Aim: The aim for the literature review is to illustrate nurses’ experiences of giving person centred care to patients with dementia. Method: A literature review with a result based on studies with a qualitative approach. Databases used was CINAHL, PsycINFO and PubMed. The fifteen articles of the result were analyzed according to Forsberg and Wengströms (2016) model of five steps. Results: The result was presented using four main themes; the organisation, patient-relations, communication, care environment and seven subthemes; workplace support, quality of competens, lack of time and personel, lifestory - a patient’s history, personal attributes, team cooperation and documentation routines. Conclusion: The health-care system is a complex organisation and the nurse faces many challenges. Insufficient support from both management and colleagues and the formation of the care environment was all factors that affected the nurses’ ability to provide person centred care. More education in communication and different types of dementia illnesses were seen by nurses as positive contribution in their work. Even the importance of having a good relationship with the patient and learn about their lifestory was brought to daylight as important components in person centred care.

Digital technologies are becoming increasingly common tools in our daily lives. We use it for finding information, but also to communicate with people all over the world. With a vision to strengthen Swedish healthcare's digital resources, Sweden has made major efforts in this area. Improved living conditions have changed the demographic situation as people grow older, which in turn places higher demands on healthcare efficiency. Being able to meet these demands has made digitalization of healthcare increasingly important, but also demonstrating new challenges such as participation, transparency and usability. The purpose of this study has been to investigate if communicative tools can be created to facilitate nurses work with person-centred care and to enhance patients' positive experiences of their own care. The study is based on interviews and observations with nurses working within orthopaedic sections and employees working in facility management as well as administration within the hospital. The results show that digital solutions can be effective tools for enhancing person-centered care, but with automated solutions the physical encounter between nurses and patients can be reduced. The concepts that have been developed are two mobile applications. They were developed with the intention to make it easier for nurses to document and communicate patients' activity and care plans.

Indiana University-Purdue University Indianapolis (IUPUI) / Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (N = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (n = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n = 23); and (4) those who rated all symptoms as highly important (n = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.

This study was conducted in order to determine how mathematics teachers allocate their time in the classroom and the factors that influence teacher priorities in that time allocation. Research has indicated that math teachers may choose not to do certain activities in their classroom because of the amount of time that they take, but other underlying reasons may exist. In order to study this idea, six math teachers were interviewed on their current time allocation and rationale for that allocation, and the results from these interviews were used to create a survey that was sent to 581 math teachers in Utah. The results from the 224 completed surveys showed that many teachers allocate their classroom time in a fairly traditional manner, with an average of about 10% of class time being spent on student-centered activities. 40.63% of teachers spent 0% of their class time on student-centered activities. There is variation in time allocation and influencing factors based on a teacher's schedule, level of teaching, experience, and how student-centered their teaching methods are. Also, the results support the claim that there are factors, other than limited class time, that affect how teachers choose whether or not to do certain activities. Some of the most significant deciding factors found are whether the activities will help students with their end of level tests, if they will keep students working hard mathematically, whether others are using those activities or not, how the activities affect classroom rowdiness. It was also found that teachers who are more teacher-centered tended to choose activities based on how easy they were to implement, including their personal comfort level, ease of preparation, and ease of management with student behavior. More student-centered teachers tended to care more about keeping the students working hard mathematically.

OBJECTIVE: Immigrants to the United States represent a variety of ethnocultural backgrounds, experiences, and languages. They face stressors unique to migration that may exacerbate or cause mental health concerns. Despite this increased risk, immigrants access treatment at rates far below their native-borne counterparts. Structural and cultural barriers to mental health service utilization expound this disparity. The present thesis proposes a novel system to provide psychosocial support for US immigrants seeking treatment at Massachusetts General Hospital (MGH).  METHODS: Recognizing the need for a new paradigm of care, an Immigrant Mental Health Center prototype was conceptualized using a Human-Centered Design approach. The foundations for this prototype align with the Patient-Centered Medical Home approach to integrated primary and mental healthcare. Narrative reviews informed the theoretical basis of the prototype. A brief review of the existing literature yielded five integrated care themes, forming the basis for prototype evaluation criteria. Communication materials for stakeholder meetings and expert advisory panels were prepared as the next step in the Human-Centered Design approach.  RESULTS: The prototype extended care to a diverse spectrum of US immigrants within the MGH healthcare network. It involved a multidisciplinary team of specialists, whole-patient orientation, a personal practitioner, increased accessibility, and viable internal (MGH) and external (community) linkages.  CONCLUSIONS: The next steps in the Human-Centered Design approach include iteratively designing solutions to co-optimize the prototype for implementation at the MGH Center for Immigrant Health. Recommendations for the iterative refinement stage include clarifying financial metrics and addressing structural barriers to treatment accessibility. A series of feasibility pilot trials and efficacy randomized-controlled trials precede implementation. Future directions include extending the target population to second or third-generation immigrants, attending to severe mental illnesses, and fostering inpatient mental healthcare linkages as a bridge to long-term care.